MNGO-14INCREASED PERIOPERATIVE MORBIDITY AND POOR SURGICAL OUTCOMES IN PATIENTS WITH ASYMPTOMATIC MENINGIOMAS

Abstract

INTRODUCTION: Conservative, non-surgical treatment has been argued as the ideal strategy for the management of asymptomatic meningiomas. Nevertheless, a significant number of patients with incidentally discovered and asymptomatic meningiomas continue to undergo operative resections. We sought to analyze the perioperative changes in performance status amongst asymptomatic patients undergoing a meningioma resection. METHODS: We conducted a retrospective cohort study on 265 patients who underwent primary meningioma resection at our institution between 2001-2013. The medical records were used to assign Karnofsky Performance Status (KPS) scores both preoperatively and postoperatively. Latest preoperative clinic or ED presentations were used to estimate the preoperative KPS. Postoperative KPS was assigned at the first outpatient clinic visit. The preoperative assessment was used to categorize patients into either asymptomatic or symptomatic patient groups based on mode of presentation and preoperative symptomatology. Mean KPS changes were compared via student's t-test and Fisher's exact test was utilized to compare differences between categorical groups. RESULTS: Overall, the mean change in KPS after operative resection was +4.30. At time of operation, 19 patients were asymptomatic and 246 patients had tumor-related symptoms. The symptomatic and asymptomatic patient groups experienced an average change of +5.0 and -5.3 in perioperative KPS respectively. 9.3% of patients in the symptomatic group and 57.9% of the patients in the asymptomatic group suffered from perioperative decrease in KPS scores. The differences in the mean changes in KPS and risk of postoperative deterioration between asymptomatic and symptomatic patients were statistically significant (p = 0.003 and p < 0.0001 respectively). CONCLUSIONS: Asymptomatic patients with incidentally discovered meningiomas are at increased risk of short-term perioperative deterioration. These patients may expect a short-term decline in performance status after operative intervention. Further studies are needed to compare the long-term functional outcomes of asymptomatic patients who are operated on versus those managed conservatively.